Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu 610041, China.
Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu 610041, China.
J Clin Anesth. 2021 Oct;73:110372. doi: 10.1016/j.jclinane.2021.110372. Epub 2021 Jun 4.
This study aimed to evaluate the efficacy of ultrasound-guided transmuscular quadratus lumborum block (QLB) combined with local infiltration analgesia (LIA) for pain management and recovery in patients who have undergone total hip arthroplasty (THA) via a posterolateral approach.
This was a prospective, randomized controlled trial.
We collected data in the preoperative area, operating room, and bed ward.
A total of 80 patients with American Society of Anesthesiology functional status scores of II-III were included and assigned to two groups, and all 80 patients were included in the final analysis.
All included patients were randomly assigned to the nerve block (group N) or the control group (group C). Patients in the group N received transmuscular QLB combined with LIA, while patients in the group C received only LIA.
The primary outcome was postoperative pain during the first active motion: it was measured at six hours after surgery and assessed using a visual analog scale (VAS). Secondary outcomes were the resting VAS scores in the post-anesthesia care unit (PACU) and at 2, 6, 12, 24, 48, and 72 h after surgery; VAS scores during motion at 12, 24, 48, and 72 h after surgery; intraoperative consumption of opioids; postoperative consumption of morphine hydrochloride; frequency of sleep interruption due to pain on the night of surgery; time until the first "walk out of the bed" after surgery; muscle strength of the quadriceps femoris; and postoperative adverse effects.
Compared to the group C, patients in the group N had significantly lower VAS scores during motion at 6, 12, and 24 h after surgery, as well as lower resting VAS scores in the PACU and at 2, 6, 12, and 24 h after surgery. Patients in the group N also consumed significantly smaller amounts of intraoperative opioids and morphine after surgery. Patients in the group N reported significantly fewer interruptions in sleep due to pain on the night of surgery and were able to "walk out of the bed" significantly earlier than those in the group C. There was no significant difference between the two groups in muscle strength of the quadriceps femoris or incidence of postoperative adverse effects.
Compared to treatment with LIA alone, ultrasound-guided transmuscular QLB combined with LIA can provide better postoperative pain relief and enhance the recovery of THA patients, since it does not cause quadriceps femoris muscle weakness and is associated with significantly lower need for intraoperative opioids.
本研究旨在评估超声引导下经腹横肌肌间 quadratus lumborum 阻滞（QLB）联合局部浸润镇痛（LIA）在经后外侧入路行全髋关节置换术（THA）患者中的疗效，以改善疼痛管理和恢复。
这是一项前瞻性、随机对照试验。
我们在术前区、手术室和病床病房收集数据。
共纳入 80 例美国麻醉医师协会功能状态评分 II-III 的患者，并将其分为两组，所有 80 例患者均纳入最终分析。
所有纳入的患者均随机分为神经阻滞组（组 N）或对照组（组 C）。组 N 患者接受经腹横肌 QLB 联合 LIA，组 C 患者仅接受 LIA。
主要结局是术后首次主动运动时的疼痛：术后 6 小时测量，并采用视觉模拟评分（VAS）评估。次要结局包括麻醉后监护病房（PACU）和术后 2、6、12、24、48 和 72 小时的静息 VAS 评分；术后 12、24、48 和 72 小时运动时的 VAS 评分；术中阿片类药物消耗；术后盐酸吗啡消耗；术后夜间因疼痛导致睡眠中断的频率；术后首次“下床”的时间；股四头肌肌力；以及术后不良反应。
与组 C 相比，组 N 患者术后 6、12 和 24 小时运动时的 VAS 评分明显更低，PACU 及术后 2、6、12 和 24 小时的静息 VAS 评分也明显更低。组 N 患者术后术中阿片类药物和吗啡的用量也明显减少。组 N 患者术后夜间因疼痛导致睡眠中断的频率明显减少，下床时间明显早于组 C。两组股四头肌肌力和术后不良反应发生率无显著差异。
与单独使用 LIA 相比，超声引导下经腹横肌 QLB 联合 LIA 可提供更好的术后镇痛效果，促进 THA 患者的恢复，因为它不会导致股四头肌无力，并且与术中阿片类药物的需求明显降低相关。
